Two years ago I addressed Ebola in this blog, and now it's again time to peruse the next threat that comes to our borders out of poor tropical countries. This time it's South America that reminds us how little attention we have paid to those resource poor countries and their health-care.
Just like Ebola this new virus has been around for quite some time in remote tropical locations. When people contracted Zika they often got over it quickly and very few died. Yet, as travelers brought it to new locations we gradually became aware of ominous complications and late effects of the disease: Damage to the nervous system in the form of microencephaly and various types of paralyses (Guillain Barré syndrome) affecting all ages.
So, again, as I asked before, what to do? Where is the vaccine, where the treatment?
Exotic diseases in poor countries don't get the same attention and priority by the pharmaceutical industry as illnesses affecting affluent countries for one reason only: There is no money in it! It is understandable that private industry must recoup their R&D expenses. In rich countries heart problems, stroke, cancer and other degenerative conditions take the front seat. Even the rarest of congenital metabolic diseases get priority because of assured reimbursement. On the other hand malaria, dengue, tuberculosis and parasitic diseases are on the back burner since poor populations cannot cover treatment costs.
As vaccines and drugs are out of reach for most indigent populations their governments have to focus on prevention. That's where the aid money from governments and big organizations should go. Small charities such as Medicorps will be very happy to assist on location if they are supported financially to carry out education, research and preventive measures such as vector control and quarantine. Unfortunately the big international organizations react all too often sluggishly, hamstrung by bureaucracy and political considerations as we experienced during the Ebola crisis in West Africa. As an example yours truly offered to assist in West Africa at that time, but hardly received any response at all since all decision makers were too busy to even schedule a meeting.
We at Medicorps have witnessed many efforts at public health education, often with dysmal results despite great expenses. We found that it is very difficult to educate and train adult, minimally educated populations in disease prevention. How do you tell a subsistence hunter to wear protective clothing when handling bush meat? How do you make an indigent village women understand all aspects of vector control when they have lived with mosquitoes all their lives and blamed illnesses on bad spirits?
The answer may be Medicorps' approach: Offer health education to the indigent children! Set up regular classes with the assistance of public health colleges and global health faculties to teach hygiene, nutrition, clean water, vector control (Anopheles!), basic biology and all the other pertinent topics of public health! . Can you imagine the wonder the first look through a microscope can instill in young children when they see what floats around in their water? Rotating medical/public health students can design curricula to address the danger of epidemics early on and assist in early detection.
We hope that those children will influence their families and friends to be careful, and why. They will likely not forget those health lessons for the rest of their lives. With the next outbreak of another epidemic they will remember the lessons of isolation, of personal protection. They will address the problem of reservoirs of standing water no matter how small.
Some of those kids may grow up to become health workers and research those diseases forgotten by big pharma. As an example we know now that hemorrhagic fevers like Chikungunya not infrequently lead to severe arthritis long after the acute phase thanks to research by Indian practitioners. The late Zika complications came to light thanks to dedicated Brazilian doctors. The problem, again, is funding. We cannot achieve quick results this way and make our donors happy in short order; we may have to wait 2 or 3 generations to see significant improvements, but then are lasting.
Children are our future; their minds are still open. Let them grow up healthy!
Gunther Hintz, M.D.